Group backs U.S. critical care changes
Thu, 19 Apr 2007 00:15:42 GMTBy JENNIFER C. YATES, Associated Press Writer
PITTSBURGH - Reorganizing the critical care system in the U.S. is the key to dealing with a looming shortage of doctors who specialize in treating critically ill patients, according to one group's recommendation.
The group — which included doctors, patients, insurers, researchers and others — believes a tiered, regionalized system for treating critically ill patients would centralize expertise and equipment while also treating the patients most in need.
Dr. Amber E. Barnato, the lead author of the report, said that although the idea of such a system isn't entirely new, the group's recommendation is unique.
"It came out of a broad-based consensus process and so it has broad-based support," said Barnato, an assistant professor at the University of Pittsburgh School of Medicine. "I think we're in trouble if we don't take a serious look at it. The current delivery system is just totally untenable."
Critical care deals with patients who require intensive monitoring in a special unit of a hospital. They are often the most critically ill patients in a hospital.
Last year, the federal Health Resources and Services Administration released a study predicting that the supply of critical care doctors, also known as intensivists, wouldn't keep pace with the country's aging population.
The government found that the number of critical care doctors would likely grow from 1,900 to 2,800 between 2000 and 2020. But as many as 4,300 such doctors may be needed by then, according to the government study.
The group's recommendations are a result of a September 2005 critical care conference and appear in the April issue of the journal Critical Care Medicine.
The conference was sponsored by the American Thoracic Society, the American College of Chest Physicians, the American Association of Critical-Care Nurses and the Society of Critical Care Medicine.
Those groups have recommended a regionalized approach in the past, but the latest report is the first time the idea has also been supported by other groups with a stake in the critical care system, said Dr. David Ingbar, president-elect of the American Thoracic Society.
Dr. John Heffner, the group's president, said there is a challenge in all medical disciplines to better coordinate care. Regionalizing critical care is one way to do that, he said.
"We do need to increase the workforce, but we do need to think in new and innovative ways," said Heffner, a critical care doctor at Providence Portland Medical Center and the Oregon Clinic.
The recommendation from the conference was the result of surveys and discussions between doctors, health professionals, insurers and other participants.
Many said organizing critical care facilities similar to how trauma centers are organized — with some being for patients with more severe injuries and others for patients in less need — might be a good solution.
"It's efficient," Barnato said. "You are basically concentrating the scarce resources."
Organizers of the conference said they hope to meet again to develop a more comprehensive plan for how a regionalized critical care system might operate, including looking into the challenges of moving critically ill patients.
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On the Net:
Society of Critical Care Medicine http://www.sccm.org
University of Pittsburgh Medical Center htt://http://www.upmc.com
1 of 4 NYC men reported binge drinking
Thu, 19 Apr 2007 00:17:03 GMTNEW YORK - One in four men in New York City reported binge drinking in 2005, or having five or more drinks on one occasion during the previous month, city Health Department said in a report released Wednesday.
The statistics — the latest available — are contained in the agency's annual community health survey of 10,000 New Yorkers, who were randomly selected and interviewed by phone throughout 2005.
The survey found that men over the age of 18 were more than three times as likely as women to binge drink.
The report said that about one in four Hispanic and white males indulged in binge drinking, compared to about one in six black men and one in eight Asian men. It also found that white women were more likely to binge drink than black, Hispanic or Asian women, but still half as likely than men.
"Alcoholism is a disease, but recovery is possible," Health Commissioner Dr. Thomas Frieden said in a statement. "Drinking too much can lead to liver damage, injuries, cancer and death." He recommended that people who regularly drink in excess seek a doctor's help or call the city's 311 non-emergency hotline and ask for LifeNet.
The Health Department said men should not have more than four drinks on one occasion or 14 in a week. Women should limit their alcohol intake to three drinks on one occasion or seven in a week, it said.
Reports of binge drinking in the city in 2005 were lower than those nationally. The Health Department said 23 percent of New York men reported binge drinking, compared to 31 percent nationally. For all New Yorkers, 14 percent reported binge drinking, compared to 24 percent nationally. For women, the number was the same — 7 percent.
The margin of error for the portion of the survey related to binge drinking is plus or minus one percentage point.
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On the Net: http://www.nyc.gov/health
Study urges caution on anemia drug use
Thu, 19 Apr 2007 00:12:36 GMTBy CARLA K. JOHNSON, Associated Press Writer
CHICAGO - A flawed Medicare payment plan encourages aggressive use of a risky and costly anti-anemia drug on many kidney dialysis patients, say researchers who warn the system should be changed.
A new study finds that for-profit dialysis chains give higher doses of the drug than nonprofit dialysis centers. That practice may be putting patients at risk of deadly side effects, some experts said.
The drug is Epogen, and Medicare pays more for it than any other single drug: $2 billion in 2005. For-profit dialysis chains report that the drug accounts for 20 percent to 25 percent of their annual net operating revenue.
Epogen is approved by the http://jama.ama-assn.org
